Case study: Psychic determinism

Psychic determinism states that all processes occurring in mind are not necessarily spontaneous and as random as they seem, but are actually determined by unconscious composites (Sauer, Spring 2011, Weeks 1-2).

2. Resistance

Resistance is a psychic force created by unconscious desires, needs, or impulses. This resistance prevents the discussion of possibly clinically relevant information into consciousness (Sauer, Spring 2011, Weeks 1-2).

3. Transference

Transference is when a patient sees someone (usually the therapist) as an important figure of their childhood or past. Consequently, the patient transfers their emotions of the other on to therapist (Freud, 1963).

4. Countertransference

Countertransference is considered as part of a psychotherapist’s emotive relationship towards a client. Or, put another way, it is a therapist’s “emotional entanglement” with a client (Freud, 1963).

5. Object Constancy

Object Constancy is when an individual creates and maintains an enduring and (sometimes) fixed relationship with a specific object (Sauer, Spring 2011, Week 4).

6. Self-representation

Self-representation is the psychological representation of one’s self within their mind. This can be seen as including how we perceive our relationships with others as well as how we react with our emotions and behaviors (Sauer, Spring 2011, Week 4).

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7. Object representation

Object representations can be explained as the emotional product that is created by objects that have great meaning to an individual early on in their childhood. These can be inanimate objects, but are usually that parents or caregiver of the child (Sauer, Spring 2011, Week 4).

8. Transitional object

A transitional object is a term used for any tangible object to which an infant or child relates a special value to. This object is needed for the child to use as a tool to transition away from mother and to create their first and genuine relationship (Little, 1985).

9. Participant observer

In the realm of a therapeutic relationship, a therapist is considered a participant observer who is unable to be considered an objective individual in regards to their opinions and beliefs about the client (Sauer, Spring 2011, Week 4).

10. Self Object

Self Objects are objects which are not experienced as separate from the self. They can be people or objects that help “complete” the self so that the individual can function (Sauer, Spring 2011, Week 5).

Part II: Short Answer Questions (5 points each, 50 points)

Provide a brief (1/2 to 1 page) response to each of the following questions. Be sure to address each part of the question.

a) What is meant by the “topographical model of the mind”? b) Describe the characteristics of each part of the topographical model.

According to the topographical model of the mind, there are three levels of consciousness: the conscious, the preconscious, and the unconscious (Sauer, Spring 2011, Weeks 1-2). The conscious is a relatively small part of the mind that contains what you are presently aware of. In this part of the mind, one can verbalize about their conscious experiences in a logical fashion. In this sense, the conscious is ruled over by the reality principle. The preconscious could be described the as conventional memory part of our mind. Thoughts and ideas that are stored here aren’t in the being used in the conscious, but they can be readily access into conscious. Lastly, the unconscious part of the mind is relatively vast in relation to the other parts of the mind. This part of the mind is not considered directly accessible to awareness. It can be thought of as a landfill for urges and feelings, or even deeper cognitions that are related to concern, conflict, and discomfort. This unconscious part of the mind is where the pleasure principles (drives) are thought to dwell from. While thoughts can flow from the preconscious to the conscious without much difficulty, the contemplations in the unconscious cannot be accessed directly from the conscious (Sauer, Spring 2011, Weeks 1-2).

a) Why is classical psychoanalysis referred to as a drive/conflict model? b) What are the primary drives in this model? c) What is in conflict?

Within classical psychoanalysis there is the premise that our thoughts and behaviors are products of our drives and the conflicts that arise from these drives. From the structural model of psychoanalysis, the super-ego is the part of the ego that deals with these conflicts that the id creates from its primary drive – the pleasure principle. Furthermore, in psychosexual development, in every stage there is a drive or aim that the child is thriving towards (Sauer, Spring 2011, Weeks 1-2). Another primary drive is aggression, a type of destructive force that is innate in all humans. Additionally, individuals have to deal with the libidinal drives and the conflicts produced by following what is socially necessary. In essence, individuals must deal with the guilt that is created by their drives. As seen by this pattern, classical psychoanalysis is a model that essentially deals with drives and conflicts that exist within everyone (Waelder, 1936). The main tenets of conflict theory consist of the resistance and repression produced by the individual (Sauer, Spring 2011, Weeks 1-2).

a) What is meant by the “structural model of the mind”? b) Describe the characteristics of each structure.

The structural model of the mind is three parts: the Id, the Ego, and the Super-Ego. This model stems from Freud’s earlier topographical work on the conscious, subconscious and preconscious and bears many similarities. The structural model is a way of describing the different forces at work within the mind (Freud, 1991). The Id is basic, instinctual and is what most closely fits the definition of “unconscious” in Freudian terms (Sauer, Spring 2011, Weeks 1-2). It is home to our impulses and basic drives, especially the drive for pleasure in all forms. The Id is devoid of judgment, like an infant, only revealing our immediate wants and desires. The Super-Ego is home to morality, judgment, guilt, and ideals of good and evil. The Super-Ego is the opposite of the Id; it is only concerned with acting in socially acceptable ways, and will ‘punish’ the Ego for bad behavior through the feelings of guilt and anxiety (Freud, 1991). Accordingly, the Ego endeavors at arbitrating between the Id and Superego (Sauer, Spring 2011, Weeks 1-2). In essence, the Ego seeks to feed the needs of the Id while still obeying the rules of the real world. Within the ideology of structural theory, the Id and the Superego are in a persistent battle. Moreover, the Ego will often protect the Id using many defense mechanisms when the Id’s cravings conflict with reality. Therefore, it is through the use of the ego that individuals are able to survive within society.

Briefly describe the Oedipus complex.

The Oedipus complex is considered the core tenet of Freud’s theory of psychosexual development. The Oedipus complex typically occurs during the third psychosexual development stage, the phallic stage. The phallic stage (3-6 years old, but the complex usually occurs around age 4-5) is the first time the child begins to explore their genitals as an erogenous zone (Sauer, Spring 2011, Weeks 1-2). Freud proposed that the defining conflict during this stage is the competition between the father and son for sexual possession of the mother. The child sees the same sex parent as a rival for their attention, so they wish to eradicate them. However, the child rarely is able to exterminate the father due to the fear of becoming a castrato in a 1990s boy band, so the child usually just gets over it. Consequently, a successful resolution of this conflict via the child’s identification with his father results in development of a mature sex role. This stage is crucial for the child’s development of sexual identity, and if the father-son conflict is not resolved, Freud says it can lead to sexual promiscuity or a puritan attitude towards sex (Freud, 1956). There is also the Electra complex, which is the female version of this problem.

5. a) How are parapraxes, dreams, and symptoms viewed from a classical psychoanalytic point of view? b) What is meant by the idea of “compromise formation”?

A parapraxis is an error that usually occurs in speech (but can also be a physical manifestation) that is psychoanalytically interpreted as occurring due to the interference of some unconscious repression (Sauer, Spring 2011, Weeks 1-2). Meaning, the word that was originally stated by the individual has some truth to it and may not entirely be an error. Freud made an eloquent statement about the importance of dreams from a psychoanalytical point of view, “If I were asked how one could become a psychoanalyst, [it would be] through the study of his own dreams” (Freud, 1910, p. 201). Dreams have been cited by Freud as the “royal road to the unconscious” (Freud, 1900). Dreams are comprised of many ideas, drives, and conflicts that may be interpreted as infantile, insane, or mature (Freud, 1910). A psychoanalytic formulation of symptoms could be explained by the concept that symptoms are caused by and relieved by continuous internal conflicts. Therefore, symptoms could each be represented by a primitive drive in conflict with the superego and the correlating psychological defenses that are generated (Waelder, 1936). Compromise formation is a type of conflict that is experienced within a dream. It is a collision of an unconscious drive that seeks fulfillment and the individual’s conscious ego that attempts to repress it (Freud, 1900). Unfortunately, or fortunately, these conflicts are rarely settled within the individual.

6. List five of the defense mechanisms. Define and provide an example of each one. Include at least one more primitive, one borderline, and one neurotic or healthier defense mechanism in your answer.

Projection: Allows the person to confront undesirable traits within themselves indirectly by attributing those traits to someone else (George, 1992). Example: A man becomes angry with his wife for not doing the dishes. He calls her lazy, a trait in himself he is unwilling to confront.

Displacement: Shifts negative, aggressive, or sexual impulses from its real object and redirects it on to a less threatening target. Example: A woman is angry with her husband for calling her lazy, but yells at her child instead.

Splitting: The person views the world in absolutes, ‘splitting’ positive and negative impulses and traits. Example: A man finds a fault in his wife, and labels her as a bad person.

Sublimation: The person uses their negative thoughts or behaviors to fuel positive ones. Example: A woman is angry and depressed over her failing marriage. Instead of crying and eating a whole tub of ice cream, she channels her anger into a vigorous run.

Somatization: Negative or aggressive feelings toward others transform into physical pain, anxiety or negative feelings toward the self (George, 1992). Example: A child hears his parents fighting. He becomes angry with his father for abusing his mother, but his father is frightening to him. The negative feelings produce a physical stomachache.

7. Describe Mahler’s developmental phases of separation-individuation.

The normal autistic phase occurs in the first couple of months of life. In this stage the infant is detached and spends most the time sleeping. It has been noted that Mahler later revoked this phase, believing it to be non-existent based on new findings from her infant research (Coates, 2004). The normal symbiotic phase is between the first 3 to 5 months of age (Sauer, Spring 2011, Week 4). The infant is now aware of the mother but no individuality has yet occurred. In a way, the infant and the mother are one at this stage. At the end of the normal symbiotic phase, the separation-individuation phase occurs. At this point, there are boundaries now realized between the infant and mother (the separation). The individuation occurs when the theoretical infant’s sense of self identity is created. The specific process of separation-individuation can be divided into four subphases – Differentiation: the period within the first few months were the infant begins to recognize the distinction between the mother and the self. Practicing occurs between 9 and 16 months and is due to the infant’s ability to walk around, explore, and become more detached from the mother. At 15 to 24 months, rapprochement is initiated and the infant reattaches to the mother. This period is when the child becomes concerned that his physical detachment will be seen as an intended separation from the mother. The last stage, consolidation, is when the child becomes relaxed to move away from their parent. This allows the ego of the parent and the child to develop into a discrete identity (Coates, 2004). However, it should be noted that interferences in this development of separation and individuation can have an effect on the sense of self for the child later in life (Sauer, Spring 2011, Week 4).

8. Briefly describe Klein’s developmental positions.

Klein’s developmental positions are stages in the normal development of a child, each with its own characteristic defenses and drives (Klein, 1946). There are two main positions: the paranoid-schizoid and the depressive. During the paranoid-schizoid position, the infant experiences many strong drives such as hunger, frustration, anxiety, and aggression (Sauer, Spring 2011, Week 4). Dichotomous thinking and projection are the child’s primary defenses at this stage. Everything is considered either good or bad, but also incomplete. The infant’s defense of projection is part of an effort to remove or control the negative emotional states. Therefore, it is theorized that eventually the infant’s ego matures in the direction of completing objects in its world to relieve its apprehensions (Klein, 1946). During the culmination of paranoid-schizoid stage, the anxieties of the paranoid-schizoid position are of a fear of the ego’s destruction. In contrast, the ego anxieties of the depressive position are because a fear of destroying others instead of destroying the self. There is a slow realization of positive and bad aspects of self and the other and an aptitude of how relationships intermingle (Sauer, Spring 2011, Week 4). The child begins to recognize that it has the ability to hurt or scare away the object it desires yet does not want. Partially due to these ambivalent feelings, the distinguishing defenses of the depressive position include mania, repression, and reparation. It should be noted that it is possible for the child to deteriorate into paranoid-schizoid position when the depressive position’s defensives are not able to protect the ego.

9. What is the difference between the true and false self, according to Winnicott?

Winnicott suggests that in each person there is a true self, which is authentic and inherent, and a false self, which adapts to outside influences in order to protect the true self (Winnicott, 2002). The true self is instinctual and most visible at infancy when the false self has not yet begun to shelter it. Winnicott noted that the caregiver’s responsiveness to the infant’s movements determines whether the true self will be developed or fail (Sauer, Spring 2011, Week 4). The false self develops to protect and shelter the true self by conforming to social codes and expectations. While the true self is always imaginative, dependable, and strong, the false self can be healthy, pathological, or both. In a way, a healthy false self can exist and not cause great distress if it is functional to both individual and society. However, if the relationship with the caregiver is not in line with the needs of the child, and the child cannot receive the attention they require, they can develop a false self. Unhealthy false selves create restlessness and a feeling of discontent within the child (Winnicott, 2002). In this state, the child’s creativity and distinctiveness are replaced with the care of others (Sauer, Spring 2011, Week 4).

10. a) Describe what Kohut meant by the concept of the self, b) What are the three poles of the self that he described and c) what kind of selfobject functions does each require?

While, Kohut did not directly define the term “self” because he recognized that it was a subjective term that should be individualized, he considered that the concept of the self could be described as the enduring evaluation that the person gives themselves (Sauer, Spring 2011, Week 5). The individual needs to independently determine their sense of self in order to be a complete person with an intact personality. Kohut noted that a large determination of how the self was developed was based on the idea of empathy. Specifically, the initial relationship between the child and their parent or guardian would decide on whether the self would be healthy or not.

According to Kohut the self can be split into three-parts – a contrast to Freud’s structural model. This tripartite consists of: the grandiose self, the idealized parent imago, and the twinship /alter-ego self. Each of these parts requires a self-object. The grandiose self needs a self-object that can help create and mirror narcissism to boost their esteem. The idealized parent imago necessitates an exemplary model as a self-object so that they child has someone or something to look up to. Lastly, the twin-ship/alter ego self entails having a similar self-object that is able to create a sense of relational identity.

Part III: Essay Questions (10 points each)

Respond to each question as fully as possible. Be sure to address each part of the question. Responses should be 1-3 pages in length.

a) What is it that makes a therapy uniquely psychoanalytic? b) How does this differ from other forms of psychotherapy such as cognitive behavioral, humanistic, etc.?

Psychoanalytic therapy attempts to demonstrate how unconscious factors (drives, conflicts, defenses, and more) can distress current relationships (Sauer, Spring 2011, Weeks 1-2). Also, psychoanalytic therapy dissects patterns of behavior, traces them back to their historical origins, to show how they have changed and developed over time, and helps the individual to deal better with the realities of adult life. Psychoanalysis frequently involves looking at early childhood experiences in order to discover how these events might have shaped the individual and how they contribute to current actions. Psychoanalysis is unique because it is based on the reflections and deep considerations of the analyst. Specifically, psychoanalysis realizes that the unconscious very difficult, if not impossible, to access. Therefore, individuals are often unaware of the factors that determine their emotions and behavior (Messer & Wolitsky, 2007).

As already noted, one of the major reasons for individuals seeking psychoanalytic therapy is due to problems in their relationships. Relationships are often a source of conflict, and they are an important source of information in psychotherapy (Messer & Wolitsky, 2007). In contrast with humanistic therapy, in the psychoanalytic approach, therapists use reconstruction to approximate what may have happened in the past that has led to the client’s current issue. The therapist directs the client to free associate by verbalizing their thoughts, fantasies, and dreams. From this, the analyst considers the unconscious conflicts that may be causing the client’s symptoms and personality problems; then, the therapist deduces explanatory ideas from them for the client. Additionally, psychoanalytic therapists employ interpretation of the patient’s unconscious conflicts (that usually began from an earlier period of life) that are interfering with present day functioning (Sauer, Spring 2011, Weeks 1-2).

Psychoanalytic approach therapists use reconstruction to approximate what may have happened in the past that has led to the client’s current issue. The therapist directs the client to free associate by verbalizing their thoughts, fantasies, and dreams. From this, the analyst considers the unconscious conflicts that may be causing the client’s symptoms and personality problems; then, the therapist deduces explanatory ideas from them for the client. This style of therapist/client interaction is believed to (through the interpretation of the therapist) permit the patient to remember added experiences, struggle with more resistance and transference, and be able to more deeply realize thoughts after finding insight within their issues (Freud, 1910). In comparison, with humanistic approach, the therapist must look the human context of the internal emotional growth of the individual with a focus on the subjective meaning, the present, a concern for positive growth rather than pathology, and the idea that we are not all predetermined to live a life without volition.

“In my early professionals years I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship in which this person may use for his own personal growth?” – Carl Rogers. Humanistic therapy focuses on the relationship between therapist and client (Rogers, 1961). The humanistic approach emerged in response to both behaviorism and psychoanalysis to amplify the idea that a man is not merely a machine. The client is the center of the therapeutic process and the therapist must listen and try to appreciate the emotions, behavior, and the overall well-being from the client’s point of view. It gives the idea that, inherently, humans have the ability to maximize potential – the self-actualizing tendency. The mission of humanistic therapy is for the therapist to create a positive environment where this predisposition may grow.

Quite the opposite from other styles, a patient being psychoanalyzed may be asked to recline on a sofa with the therapist out of view (Freud, 1910). This style of therapist/client interaction is believed to (through the interpretation of the therapist) permit the patient to remember added experiences, struggle with more resistance and transference, and be able to more deeply realize thoughts after finding insight within their issues. In comparison, with humanistic approach, the therapist must look the human context of the internal emotional growth of the individual with a focus on the subjective meaning, the present, a concern for positive growth rather than pathology, and the idea that we are not all predetermined to live a life without volition.

In cognitive therapy, the therapist helps the patient learn to identify their maladaptive cognitions that lead to dysfunctional beliefs (Freeman, Pretzer, Fleming, & Simon, 1990). What makes this treatment unique is that it is a very directive approach to therapy. The therapist faces the client and uses verbal and non-verbal empathetic behavior to show to the client interest and concern in regards to their problems. In a real way, both the client and therapist get to keep control over the substance and tempo of the therapy. From the clients’ point of view, it can be said that the therapist isn’t judging them, evaluating them, or trying to “figure out how their mind works.” In other words, the focal point of cognitive approach is that the therapist is listening, reflecting, and redirecting the client. From this, the therapist places a significant emphasis on the client’s current experiences over the influence of precedent experiences.

How did the case of “Anna O.” contribute to the origin and development of psychoanalysis? Discuss at least five important points in your answer.

In 1885, Freud left Vienna for Paris to study under the famous neurologist Charcot (Webster, 2003). Charcot specialty was in treating patients who were suffering from a variety of unexplained physical symptoms such as paralysis and seizures. They noted that individuals who were suffering were not due to the physical consequences of the accident, but from the idea they had taken away from the event. Freud became curious by Charcot’s work on traumatic hysteria and considered that one of the principal forms of neurosis came about when a traumatic experience led to the creation of an unconscious symptom-formation. Freud began to develop this idea, partly by reference to the work of his colleague Josef Breuer. Freud was especially interested in the most unique of all Breuer’s patients, ‘Anna O.’

Anna O. was a 21 year-old woman who had become sick while nursing her dying father. Anna O noted that she had many symptoms, including: a nervous cough, anorexia, suicidal ideation, sleepwalking, rages, tics, squints, paralyses of her arms and neck, temporary blindness, an inability to speak, difficulty drinking, and dissociative episodes (Sauer, Spring 2011, Weeks 1-2). Breuer diagnosed Anna O.’s illness as a case of hysteria and progressively developed a form of therapy which he believed was effective in removing her symptoms (Freud, 1905). A sudden disappearance of one of Anna O.’s many symptoms became the basis for what Breuer later described as a ‘therapeutic technical procedure’. According to both Freud and Breuer, this method was applied systematically to each of Anna’s symptoms and as a result be freed from her hysteria.

Anna O. played an essential role in the development of Freud’s growth as a psychoanalyst. Psychoanalysis as we know it today may never have come into being if Freud had not merged Breuer’s ‘talking cure’, traumatic hysteria, and his own elaborate technique for reconstructing repressed memories through interpretation (Sauer, Spring 2011, Weeks 1-2). Consequently, Freud began to construe his patients’ illnesses as hysteria and went about uncovering the traumatic incident which had supposedly given rise to their symptoms. In order to help the process of analysis he developed what he called his ‘pressure technique’ (Freud, 1905). This method relied on applying pressure to his patients’ forehead with his hands and instructing them to report faithfully ‘whatever appeared before their inner eye or passed through their memory at the moment of pressure’. Freud considered this method as an effective way to induce pictures, ideas, or unconscious thoughts. This concept would later become the basis of Freud’s concept of free association (Freud & Breuer, 1985).

When Anna O. had a new symptom appear and regressed somewhat into her former hysterical self, Freud drew conclusions about this “resistance” on the part of the patient pathology (Freud & Breuer, 1985). From this, Freud hypothesized that hysterical symptoms develop out of unconscious wishes, or conflicts, which cannot be openly expressed and are in turn repressed. These repressions of the mind are “converted” into bodily symptoms, the beginnings of psychosomatic thought. To counteract this, Freud suggested that by making the unconscious, conscious, one could stop physical manifestations and hysteria. Additionally, by recalling, reiterating, and talking about past experiences, a patient could find relief from their ailments.

The case of Anna O. also led Freud to propose that by examining the patient’s dreams and other internal representational material, one may be able to gain admission the unconscious (Freud, 1905). Additionally, Anna’s hysterical pregnancy and Breuer’s abrupt termination with her because of his fears and concerns was the catalyst for the concepts of transference and countertransference. These conceptions would later become a significant part of the treatment of psychoanalysis. Consequently, Freud noticed that many hysterical female patients reported memories of sexual abuse or trauma by male relatives and family friends. Freud’s notice of this pattern may have become the basis of Freud’s stages of psychosexual development.

Compare and contrast classical psychoanalysis, object relations theory, and self psychology in terms of a) how they perceive the origins of psychopathology, b) how they view and approach treatment and the therapeutic relationship, and c) what is considered curative in treatment. If desired, you may use a table like that below for your response.

Type of Psychoanalysis

Classical Psychoanalysis

Object Relations

Self Psychology

Origins of Psychopathology

Experiences are expressions of the child’s own sexual wishes and fantasies. Since these wishes are not usually acceptable, they are repressed and subsequently expressed in the form of symptoms.

The internalized early relationships with our caretakers become the model for subsequent relationships. If the internalized sense of self and object relationships are not genuinely satisfied, these voids will be acted out in later life.

Reflecting “disorders of the self” or arrested self-development. Disorders of the self arise out of problems in empathic attunement in early childhood relationships that lead to a failure to develop a mature, cohesive sense of self.

Approach to Treatment

A patient must be able to let go of the repression and resistances so that they are able to view the contents of their unconscious and become aware of these emotions – either accept or deny them.

The patient needs to view the therapist and the therapeutic relationship as a recreation of previous object relationships. Treatment becomes a chance to re-internalize a new healthy object relationship.

Self psychology places a greater emphasis on the importance of empathy in all relationships. It is considered the psychoanalytic method of observation.

What is curative?

Making the unconscious conscious by overcoming the patient’s resistances and repression.

The re-experiencing of nourishing and fulfilling relationship within the therapy.

Empathy – the ability to see and understand things from another’s point of view.